Meds or No Meds? How to Treat a Child with ADHD

New clothes and notebooks and talk about favorite friends and tough teachers have made their way into American homes amid the exuberance and anxiety of a new school year. But for the millions of parents whose children struggle with attention deficity hyperactivity disorder, the back-to-school swirl of activity is tinged with another worry: whether behavioral challenges will stand in the way of their child's ability to learn and succeed.

Just how many parents are grappling with these worries? Eleven percent of all children between ages 4 and 17, or 6.4 million American kids, have been diagnosed with ADHD, according to a New York Times report. Those numbers reflect a 41 percent jump in the last decade, with two-thirds of kids diagnosed being prescribed stimulant medications for treatment. The Times analyzed 2010 data from the U.S. Centers for Disease Control and Prevention, which currently lists 2007 data on its website. The CDC will release an analysis of the latest statistics soon, according to an agency spokesperson.

In the wake of that news came a study published in June that looked at increased use of stimulant medication to treat ADHD following expanded insurance coverage in Quebec, Canada. The study, conducted by researchers at the National Bureau of Economic Research, found "evidence of increases in emotional problems among girls and reductions in educational attainment among boys."

Such reports have fueled increasing concern about the extent to which kids are diagnosed and medicated for ADHD, a condition parsed into three general categories: attention difficulties; hyperactivity and impulse control; and a combination of both behaviors.

In place of drugs, which can carry side effects including stunted growth, abdominal pain and loss of appetite, some advocate for an increased reliance on cognitive and sensory techniques, although the European Network Adult ADHD - a panel of 40 experts from 18 countries - says these psychotherapeutic treatments have yet to show any substantial impact.

The issue, experts say, is much more complex than whether to treat ADHD with or without drugs and the alleged overmedication of American youth.

"The concept of this perfectionist-driven, overachieving society pushing medications on children so they'll do better in school or beat out other kids or whatever, it just doesn't correspond with what we hear from parents, who will try almost any alternative to giving their children psychiatric medications," says Susan Caughman, editor in chief of ADDitude, a magazine for people affected by ADHD and learning disabilities. At issue, instead, are biases against mental health that cause prejudice treatment and a health care system that can't possibly cope with the number of kids and parents who need help, she says.

"There's a very strongly held myth that ADHD isn't real ... that it's a function of bad parenting, that it's undisciplined children that need to be reined in," she says, citing research to the contrary outlined in Judith Warner's book, "We've Got Issues: Children and Parents in the Age of Medication."

Effective treatment hinges on meeting the unique needs of each child, explains Anthony Rostain, a professor of psychiatry at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. "Most kids benefit from a medication, but not all kids do, and not all kids are on the right dose," he says. "I think it requires very careful skepticism on the part of people who take meds or who prescribe meds that they have to be much more selective about what are they targeting."

Rostain sees promise in newer techniques like biofeedback, a neurological exercise that helps patients strengthen cognitive skills. Leading health authorities like the CDC prescribe a protocol on treatment guidelines. The American Academy of Pediatrics, for example, notes that primary care doctors should check for corollary conditions like anxiety or depression and, in the case of preschool kids, behavior therapy should be the first mode of treatment.

Rostain advises concerned parents to first consult with their child's primary provider, who can suggest a specialist. From there, learn as much as you can about various treatment tools available, such as counseling, medication, diet and skills training to determine the best strategy for your child. "Just giving kids meds is not the right answer," Rostain says. "But not giving kids meds is also not the right answer."

Indeed, for all the buzz over the aforementioned Quebec study, its conclusion makes a similar point. The crux of the issue is not so much the use of ADHD medication as misuse: "Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication use can have negative consequences given the average way these drugs are used in the community."

As Caughman explains, medications can be a useful intervention in helping children learn skills that, in their absence, could hinder a child's lifelong success and self-esteem. "Are they a cure for ADHD? No," she answers. They provide kids with "a short-term ability to focus" so they can employ other treatments for the long run.